A Hub and Spoke Learning Program in Bariatric Surgery in a Small Region of Italy

Abstract

BackgroundMetabolic and bariatric surgery (BS) are considered life-changing and life-saving treatments for obese patients. The Italian Society of Obesity Surgery (SICOB) requires at least 25 operations per year to achieve the standard of care in the field. Despite the increasing need to treat obese patients, some small southern regions of Italy, such as Molise, do not have enough experience in bariatric procedures to be allowed to perform them. Therefore, our aim was to run a Hub and Spoke Program with a referral center in BS to treat obese patients and provide a proper learning curve in BS in Molise.MethodsIn 2020, the “A. Cardarelli Hospital” in Campobasso, Molise, started a formal “Learning Model of Hub and Spoke Collaboration” with the Hub center “Ospedale Del Mare”, Naples. A multidisciplinary approach was achieved. Patients were supervised and operated under the supervision and tutoring of the referral center. We retrospectively reviewed our prospectively collected database from February 2020 to August 2021 in order to analyze the safety and effectiveness of our learning program.ResultsIn total, 13 (3 men and 10 women) patients underwent BS with the mean age of 47.08 years and a presurgery BMI of 41.79. Seven (53.84%) patients were the American Society of Anesthesiologist (ASA) II, and 6 (46.16%) patients were ASA III. Twelve (92.31%) procedures were laparoscopic sleeve gastrectomies, 1 (7.69%) patient underwent endoscopic BioEnterics Intragastric Balloon (BIB) placement. One (8.33%) sleeve gastrectomy was associated to gastric band removal. Mean surgical time was 110.14 ± 23.54 min. The mean length of stay was 4.07 ± 2.40 days. No Clavien-Dindo ≥ III and mortality were reported. The follow-up program showed a mean decrease of 11.82 in terms of body mass index (BMI) value. The last 5 procedures were performed by the whole equips from “A. Cardarelli” under external tutoring without any impact on complication rate.ConclusionThe setup of a proper Hub and Spoke Program may allow to perform BS to provide the standard of care. This approach may reduce health costs and related patient migration.

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“…Furthermore, the geographical and social limitation of Molise, already discussed in other experience [38], caused a longer hospital stay due to the lack of social supports and peripheral care, with, consequent, higher hospital related complications [39].…”

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“…However, the H&S offers a paradigm change in surgical education: the Hub offers mentorship, ensuring standardization of training, while spoke unites benefit of huge cohort of patients and hands-on clinical experience [ 13 , 45 , 46 ]. Consequently, decentralization and collaboration programs between H&S Unites achieve an adequate experience in spoke surgeons also to perform major surgical procedures as HPB surgery [ 13 , 47 ]. Conserning patients’ point of view, the H&S increases access to surgical education in underserved or remote areas, allowing trainees to learn and perform surgical procedures in their local Units.…”

“…Conserning patients’ point of view, the H&S increases access to surgical education in underserved or remote areas, allowing trainees to learn and perform surgical procedures in their local Units. This approach is very useful for the managing of CRLM because, often primary cancer is diagnosed and treated in peripheral centers, so the chance to treat CRC simultaneously to LM allow to reduce health mobility to HPB referral centers with the sparing of related costs [ 46 , 47 ].…”

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“…A huge number of Hub and Spoke learning programs allowed the peripheral center to achieve high specialization in HPB [ 2 ]. During the pandemic, these programs always granted the standard of care for patients with consequent savings of time and money, avoiding the costs of health mobility [ 30 ].…”